Surgical instrument



Feb. 13, 1951 J HELD SURGICAL INSTRUMENT Filed July 51, 1948 INVENTOR. LJUSEFHEHELD BY P ATTDENEY Patented Feb. 13, 1951 SURGICAL INSTRUMENT Joseph Edward Held, New York, N. Y., assignor to American Cystoscope Makers, Inc., New York, N. Y., a corporation of New York Application July 31, 1948, Serial No. 41,753

8 Claims. 1

This invention relates to a surgical instrument, and more particularly to such an instrument adapted to be used advantageously in endocholedochal sphincterotomy.

It has been ascertained that acute pancreatitis may be produced by the retrojection of bile into the pancreatic duct should the ampulla of Vater become occluded by a stone. It has also been determined that spasms of th sphincter of Oddi may produce suflicient temporary constriction and obstruction of the same to enable bile to enter the pancreatic duct. Spasms of the highly labile sphincter of Oddi muscle may be produced by intense pain, drugs or other means. Obstruction of the duct by such spasms can be prevented by cutting the sphincter with the aid of the instrument of this invention, thereby eliminating a potential cause of such obstruction.

It is the primary object of this invention to provide an instrument adapted to be advantageously employed in internal surgical procedures.

The invention has for another object the provision of a surgical instrument adapted to be readily inserted to the region of and sever the sphincter of Oddi muscle.

It is a further object of the invention to provide an instrument of the character indicated that is capable of performing its intended functions in an effective and trouble-free manner.

The foregoing objects, as well as other objects, and the advantages obtainable by the practice of this invention will be readily apparent to persons skilled in the art upon reference to the following detailed description taken in conjunction with the annexed drawing, which respectively describes and illustrates a preferred embodiment I of the invention.

In the drawing:

Figure 1 is a view in side elevation, partly in longitudinal cross section, of an instrument constructed in accordance with this invention;

Figure 2 is an enlarged view of the left-hand portion of Figure 1, with certain parts shown in central cross section;

Figure 3 is a View taken along line 3--3 of Figure 2; and

Figure 4 is a view taken along line 44 of Figure 2.

Referring to the drawing, wherein like reference numerals denote corresponding parts throughout the several views, and more particularly to Figure l, a forceps control unit, generally indicated by numeral [0, includes a support body [2 formed with a saddle l4 at its forward end portion and slotted, as indicated at IS. A first handle l8, preferably integral with support [2, is provided with a thumb-receiving loop 20. A second handle 22 has its upper portion disposed in slot l6 and is pivotally connected to the support by a screw 24. Handle 22 is provided with a fingerereceiving loop 25 at its lower end, and is secured at its upper end to a block 28 that is slidable with respect to support l2.

The rearward portion of an arcuate sheath or tube 38 is positioned in and attached to saddle M. A plug 32 closes the forward end of sheath 3!). As is indicated in the various views, the plug and the immediately adjacent external portions of the sheath are rounded so as to facilitate introduction of the instrument into a body passage without excessive trauma.

The sheath is formed with a pair of diametrically opposed slots 34 and 36, the latter consisting of a forward portion of enlarged width 38 and a merging rearward portion of reduced width 40.

A flexible rod 42 has its major portion positioned within sheath 30. The rod has its rearward end connected to block 28 and is reciprocable along the path defined by the interior of the sheath in response to alternate forward and rearward pivotal movement of handle 22 with respect to handle I 8. The forward extremity of rod :22 is slotted or bifurcated, as indicated at 44-. A cutting element, such as a knife 46, having a preferably toothed cutting edge 48, registers with slot 44 in rod 42 and is pivotally connected to the rod by a pin 56. Cutting element 46 is also pivoted to sheath 3!? by means of a second pin 52, the axis of which is parallel to and disposed rearward of the axis of pin 5c. Each of a pair of spacer sleeves 513, concentric with pin 52, is positioned intermediate a side surface of the cutting element and the interior surface of the sheath to maintain the cutting element in the illustrated spaced relation to the sheath.

For the purpose Of briefly outlining the operation of the instrument in a sphincter-severing procedure, it is first assumed that the parts are assembled and in the relative osition shown in Figure 1. Before the instrument is placed in use, the operator inserts his thumb in loop 20 and a finger in loop 26, and urges handle 22 in a counter-clockwise direction of rotation about the axis of pivot screw 2d, as viewed in Figure l, to thereby move flexible rod 42 forwardly along the interior of sheath 3!] and effect counter-clockwise rotation of cutting element 46 about its pivotal connections with the rod and the sheath, whereby 3 the toothed portion of the cutting element is retracted in slot portion 40.

By virtue of the construction herein illus trated and described, the sheath may be inserted through the common duct into the duodenum until it elevates the anterior duodenal Wall. Handle 22 is then moved in a clockwise direction, thereby effecting corresponding clockwise pivotal movement of cutting element at to dispose the cutting element in open position (Figure 1). With the cutting element thus in open position, the instrument is withdrawn to a sufiicient extent so that the cutting element engages the papilla. The control forceps is now actuated to impart counter-clockwise rotation to cutting element 46, thereby effecting severance of the sphincter of Oddi in one plane.

From the foregoing, it is believed that the con struction, operation, and advantages of my present invention will be readily comprehended z.

by persons skilled in the art. It is to be clearly understood, however, that various changes in the apparatus set forth above may be made without departing from the scope of the invention, it being intended that all matter contained in the description or shown in the drawing shall be interpreted as illustrative only and not in a limiting sense.

I claim:

1. A surgical instrument comprising a sheath having a slot formed therein, a rod reciprocable in the sheath, a cutting elem nt independently pivoted to the rod and the sheath and registering with the slot, and means for impartin reciprocatory movement to the rod with respect to the sheath to thereby effect corresponding movement of the cutting element about its pivotal connections with the rod and sheath.

2. A surgical instrument comprising an areuate sheath having a longitudinal slot formed in its forward portion, a flexible rod reciprocable in the sheath, a cutting element independently pivoted to the forward portion of the rod and to the sheath and registering with the slot, and means secured to the rearward portion of the sheath and the rod for imparting reciprocatory movement to the rod with respect to the sheath to thereby efiect corresponding movement of the cutting element about its pivotal connections with the rod and sheath.

3. A surgical instrument in accordance with claim 2 wherein the sheath is closed at its forward end and the cutting element is pivoted to the sheath rearward of its pivotal connection with the rod when the cutting element is in retracted position with respect to the sheath.

4. A surgical instrument comprising a sheath closed at its forward extremity and having a longitudinal slot formed therein, a rod reciprocable in the sheath, the forward end portion of the rod being slotted, a cutting element registering with the slots in the rod and the sheath and independently pivoted to the rod and sheath, and means connected to the rear portions of the sheath and the rod for imparting reciprocatory movement to the rod with respect to the sheath to thereby effect corresponding movement of the cutting element about its pivotal connections with the rod and sheath.

5. A surgical instrument comprising an arcuate sheath closed at its forward end and having a longitudinal slot formed therein, a flexible rod reciprocable in the sheath, the forward end portion of the rod being slotted, a cutting element registering with the slots in the rod and the sheath and independently pivoted to the rod and sheath, and means connected to the rear portions of the sheath and the rod for imparting reciprocatory movement to the rod with respect to the sheath and corresponding movement to the cutting element about its pivotal connections with the rod and sheath.

6. In an instrument of the character described, a control unit comprising a support, a first handle rigidly secured to the support and a second handle pivotally connected to the support, a sheath mounted on and projecting forwardly of the support, said sheath having a longitudinal slot formed in its forward portion, a rod slidable in the sheath, said rod being connected to the second handle and reciprocable in the sheath in response to pivotal movement of the second handle with respect to the support, and a cutting element pivoted to the forward portion of the rod and to the sheath and registering with the slot.

7 In an instrument of the character described, a control unit comprising a support, a first handle rigidly secured to the support and a second handle pivotally connected to the support, an arcuate sheath mounted on and projecting forwardly of the support, said sheath having a longitudinal slot. formed in its forward portion, a flexible rod slidable in the sheath, said rod being connected to the second handle and reciprocable in the sheath in response to pivotal movement of the second handle with respect to the support, and a cutting element pivoted to the forward portion of the rod and to the sheath and registering with the slot.

8. An instrument in accordance with claim 7 wherein the forward extremity of the sheath is closed and, the cutting element is pivoted to the sheath rearwardly of its pivotal connection with the rod when the cutting element is in retracted position with respect to the sheath.

JOSEPH EDWARD HELD.

REFERENCES CITED The following references are of record in the file of this patent:

FOREIGN PATENTS Number Country Date 50,053 Austria Sept. 25, 1911 OTHER REFERENCES Catal0gAloeSharp and Smith Hospital Division, page 21-7. 

